Medicine and Health Sciences Commons^™

The Effect Of Change In Medi-Cal Dental Coverage On Dental Care Utilization Among Medi-Cal Beneficiaries, Min H. Zhang

Theses and Dissertations

One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 …

Genome-Wide Systems Genetics Of Alcohol Consumption And Dependence, Kristin Mignogna

Theses and Dissertations

Widely effective treatment for alcohol use disorder is not yet available, because the exact biological mechanisms that underlie this disorder are not completely understood. One way to gain a better understanding of these mechanisms is to examine the genetic frameworks that contribute to the risk for developing this disorder. This dissertation examines genetic association data in combination with gene expression networks in the brain to identify functional groups of genes associated with alcohol consumption and dependence.

The first study took advantage of the behavioral complexity of human samples, and experimental capabilities provided by mouse models, by co-analyzing gene expression networks …

Modulation Of Autophagy And Senescence To Enhance The Response To Therapy In Triple Negative Breast Cancer, Liliya Tyutyunyk-Massey

Theses and Dissertations

Abstract

Although great strides have been made over the decades in development and optimization of anti-cancer therapies, even highly effective drugs often fail to completely eliminate tumors. Residual tumor cells can enter into a state of dormancy for prolonged periods of time but eventually are able to regain proliferative capacity and reemerge as chemotherapy-resistant disease. Because recurrent disease is a leading contributor to patient’s mortality, it is paramount to identify strategies for effectively destroying residual tumor cells.

Cytotoxic drugs and ionizing radiation are used as standard therapies in a variety of cancers. These modalities induce apoptosis, autophagy and senescence. Senescence …

Targeting Sphingosine Kinase 2 As A Treatment For Cholangiocarcinoma, Anthony D. Stillman

Theses and Dissertations

Cholangiocarcinoma (CCA) has a high mortality rate and its occurrence is rising. This increase prompts the need for improved CCA treatments. Studies have suggested that CCA is highly reliant on the sphingosine-1-phosphate-receptor-2 (S1PR2) and sphingosine kinase 2 (SphK2). Recently, a competitive SphK2 inhibitor, ABC294640, has been approved for clinical trial. ABC294640 has the potential to treat CCA, which is support by a phase I clinical study that was able to temporarily treat a patient suffering from metastasized CCA with ABC294640. To determine the viability of ABC294640 as a treatment for CCA, this study focused on determining the effects of ABC294640 …

2nd Tier Assay For The Detection Of Congenital Adrenal Hyperplasia By Virginia’S Newborn Screening Laboratory: Steroid Profile By Hplc-Ms/Ms, Christopher E. Nixon

Theses and Dissertations

Congenital Adrenal Hyperplasia (CAH) encompasses several disorders related to disruptions in the adrenal steroid production pathway. These disruptions may cause virilization of the external female sex organs, incorrect gender assignment, precocious puberty, and in the most severe form, may cause life-threatening salt wasting and adrenal crisis if not detected and treated early in the newborn period.

17α-Hydroxyprogesterone (17-OHP) is the primary target for immunofluorescence detection of CAH from dried blood spots in newborn screening (NBS). Unfortunately, current immunoassay techniques for the detection of CAH suffer from high false positive rates. The primary factors contributing to false positive determinations can include …

The Influence Of Training On Kinematics Related To Knee Injury In Novice Runners, Kathryn Harrison

Theses and Dissertations

Running is known to provide important health benefits. However, the incidence of injury among runners is high, particularly among novice runners, which discourages long term participation in the sport. The knee is the most commonly injured joint in novice runners. In general, aberrant frontal and transverse plane kinematics are associated with the development of knee injuries in runners. It was unknown whether the high rate of knee injury in novice runners was due to abnormal kinematics. Further, it was unclear whether these risk factors for injury could be improved. This dissertation includes four studies investigating kinematics in novice runners, how …

Motivational Interviewing In A Team-Based Wellness Clinic: Perceptions And Fidelity, Jodi M. Winship

Theses and Dissertations

INTRODUCTION: Motivational Interviewing (MI) is an evidenced based counseling style to elicit health behavior change. Team-based student clinics are an ideal climate for students to learn and practice team-based care, yet little is understood as to how client-centered communication styles such as MI are implemented in a team setting.

PURPOSE: The purpose of this dissertation was to conduct an exploratory study using mixed methods to better understand how an MI training translates to team-based communication with clients, the factors impacting team-based implementation of MI, and how team-based MI impacts clients’ perceived autonomy at a student-led, interprofessional, team-based wellness clinic for …

Stat5b And Stat5 Tetramers Are Essential For Ige-Mediated Mast Cell Function, Kasalina N. Kiwanuka

Theses and Dissertations

Signal Transducers and Activators of Transcription (STATs) are latent transcription factors that mediate several cellular responses. This protein family consists of seven members, STAT1 – 6 including two closely related molecules, STAT5a and STAT5b, that show 96% amino acid sequence homology and are critical for lymphoid, myeloid and erythroid cell development and function. Activated STAT proteins dimerize and translocate to the nucleus, where they bind to high-affinity DNA motifs to modulate gene expression. We recently identified STAT5b as the critical regulator of IgE-mediated cytokine production in mast cells. STAT5b knockout (KO) cells show decreased sensitivity to IgE-mediated passive systemic anaphylaxis …

An Evaluation Of Differences In Motivations To Receive Cervical Cancer Screening And Follow-Up Care Between Black And White Women, Ashlee Sawyer

Theses and Dissertations

Background: Cervical cancer among Black women is a major individual and public health concern. Despite advancements in medical technology and policy, disparities in cervical cancer diagnosis and mortality still exist between White and Black women, with Black women having higher rates of diagnosis (10.0 vs 7.1 per 100,000) and mortality (4.1 vs 2.0 per 100,000). Previous studies have focused heavily on barriers to obtaining cervical cancer screening among Black women and efforts to improve screening rates. Despite speculation by researchers that gaps in receipt of quality follow-up care may contribute to disparities, its role in disparate mortality rates between Black …

Pharmacological Assessment Of Adjuncts To Enhance Mu-Opioid Receptor Agonist Antinociception In Male Rhesus Monkeys: Does One + One = Three?, Jeremy Cornelissen

Theses and Dissertations

Mu-opioid receptor (MOR) agonists are effective agents for pain management, but are also limited by a number of undesirable effects. One approach to enhance the therapeutic effects and minimize the undesirable effects of MOR agonists may be to combine MOR agonists with an adjunct targeting a different receptor system. This targeted medical approach, known as “combination therapy”, aims to augment the desired effects of the MOR agonist (i.e. antinociception) and/or diminish the undesirable deleterious side effects of the MOR agonist. This dissertation investigated the utility of this approach in an assay of thermal nociception and schedule-controlled responding in male rhesus …

Examining Sleep And Family Functioning In Pediatric Craniopharyngioma Using Ecological Momentary Assessment, Nour Al Ghriwati

Theses and Dissertations

Craniopharyngiomas are among the most common brain tumors in children and are associated with greater rates of sleep problems compared to other pediatric cancers. However, research examining sleep among youth with craniopharyngioma has been limited by a reliance on retrospective reports or sleep studies. Families also play a crucial role in children’s adjustment following a pediatric cancer diagnosis, yet remarkably little is known about transactional associations between family functioning and sleep in pediatric cancer. This study examined cross-sectional and daily associations among family functioning, affect, and sleep difficulties for youth with pediatric craniopharyngioma using retrospective reports and ecological momentary assessment …

Molecular Pharmacology Of Non-Phyto-Cannabinoid Approaches For Treatment Of Neuropathic Pain, Nadejda A. Blajkevich

Theses and Dissertations

Approximately twenty million people in United States have some form of peripheral neuropathy. It has been shown that the CB₂ cannabinoid receptor is upregulated when there is peripheral nerve injury and activating the CB₂ receptor produces anti-inflammatory effects that translate to a reduction in signs of “neuropathic pain” in animal models. Elevating endogenous cannabinoids by inhibiting degradative enzymes has also been used to reduce neuropathic pain signs in laboratory animal models of pain. We hypothesize that the molecular pharmacology of these two approaches can be leveraged to optimize CB₁/CB₂ activation to improve non-phyto-cannabinoid treatments for …

The Effect Of Quercetin In Periodontal Inflammation, Sara Holden

Theses and Dissertations

Purpose: To determine the effect of Quercetin, a plant based over the counter flavonoid, on periodontal inflammation in a murine model of periodontitis.

Methods: Periodontitis was induced in age and gender matched mice (C57BL/6) using ligatures on the left side of the maxilla and right side was left un-ligated as baseline control. The animals received daily Quercetin gavage or Phosphate Buffered Saline (PBS) starting 5 days prior to ligation which continued throughout the experimental protocol. Micro-computed tomography (micro CT) imaging was used to determine alveolar bone loss. Real Time quantitative (qRT) PCR was used to determine level of gingival tissue …

Examining The Learning Of Students Participating In An Interactive Simulated Patient Experience, Mary Smyers

Theses and Dissertations

Simulated patients are becoming increasingly used in the educational program of future speech-language pathologists. The use of standardized patients provides the opportunity to teach students clinical skills in a controlled environment (Bradley, 2006; Zraick, 2012). Simucase, a speech-language pathology software program, allows clinicians to practice their assessment and treatment skills on virtual patients and is a valid method when teaching clinical skills. Thus, this project examined five undergraduate senior clinicians’ performance and reflection about the Simucase program and their own clinical knowledge. The undergraduate student clinicians engaged in controlled simulation experiences that shared similar characteristics to their current clients, and …

P300 Event-Related Potentials To A Phoneme Discrimination Task Requiring A Motor Response, Kaitlyn Chelsea Turner

Theses and Dissertations

Speech perception typically takes place within the auditory cortex as evidenced by data collected using quantitative electroencephalography (qEEG). The purpose of this study was to determine if motor responses influence speech perception. We examined P300 event-related potentials during oddball stimulus recognition tasks that either required or did not require a motor response. Based on a review of the literature, it was hypothesized that similar areas of the brain would be activated in both the motor response task and the same task without a motor response immediately following the button-push condition. Two syllables, /ba/ and /ga/, were presented to 20 native …

An Evaluative Study Of A Health Information Management Program Following A Significant Curricular Change, Jennifer Lynn Peterson

Theses and Dissertations

The advent of electronic health records (EHRs) has led to significant changes in the role of those who managing patient health information, Health Information Management (HIM) professionals. These changes have further led to significant changes in the educational training required for HIM professionals, leading to new curriculum requirements. Based on the need for well-prepared professionals in the changing HIM environment, it is essential to insure that educational programs are effectively preparing students for the new roles they will be expected to fill. This study is an in-depth case study of the HIM academic program at Illinois State University. The purpose …

A Systematic Approach To High Blood Pressure Risk Analysis And Healthcare Cost Reduction In Young Adults [Metodología Sistemática Para El Análisis De Riesgo Y Reducción De Costos De Servicios Médicos De Hipertensión En Adultos Jóvenes], Francisco Rafael Torres Diaz

Theses and Dissertations

The purpose of this research is to utilize publicly available data to estimate the current rate of occurrence of undiagnosed High Blood Pressure (HBP) in young adults (18 to 24 years old) and the out-of-pocket healthcare expenses associated with complications of HBP, to provide feasible alternatives to mitigate the effects on a region's economy. This has been done by building a Risk Factor Simulation Model that utilizes known HBP risk factors’ correlation to HBP, insurance coverage data, and rate of diagnosis to formulate the average Risk Factor Value for a region, which through an Annual Expected Cost Function estimates the …

The Cardiovascular Demands Of Division I Sideline Cheerleaders During Training And Football Games, Mckenna Cornett

Theses and Dissertations

The purpose of this study was to evaluate the autonomic balance and cardiovascular demands of collegiate sideline cheerleaders between practice and game settings, and throughout four quarters of a football game; and to evaluate the physical fitness of collegiate Division I cheerleaders. Eleven cheerleaders volunteered to participate (age; 18.9+0.8y, height; 163.2+4.3cm, and body mass; 64.9+8.7kg). Basic physical fitness was assessed by evaluating blood pressure, resting heart rate, grip strength, and body composition. Physiological data (maximal heart rate [HR], average HR, physiological intensity, physiological load, maximal activity, and average activity) were collected at four practices and four games using a Zephyr …

Effects Of Blood Flow Restriction Training On Healthy Individuals Using The (B)Strong Training System: A Randomized Controlled Trial, Mallory Rockhill

Theses and Dissertations

The purpose of the study was to examine and compare muscular fitness and subjective muscle pain between blood flow restriction (BFR) training using the (B)Strong Training System and traditional resistance training program after a 7-week intervention. Thirty-one healthy male and female young adults volunteered to participate. Participants were randomly selected into three groups: HIRES (high intensity resistance training), LIBFR (low intensity blood flow restriction training) or CON (control). All participants refrained from structured activity outside of this study for the duration of the entire study. Anthropometrics, body composition, muscular strength and endurance were measured prior to and post training. Delayed …

Vocational Rehabilitation Counselors' Experiences, Perceptions, And Readiness Related To Self-Employment Of People With Disabilities, Deborah Ashley

Theses and Dissertations

The purpose of this dissertation study was to explore the experiences, perceptions, and readiness (EPR) of vocational rehabilitation counselors (VRCs) supporting people with disabilities (PWD) in self-employment. While PWD are twice as likely to be self-employed than the general population, self-employment case closure rates within vocational rehabilitation remain historically low around 2%.

Descriptive, inferential, and correlational statistical analysis were used to investigate the EPR of 205 Certified Rehabilitation Counselors across the nation via an online survey, the Vocational Rehabilitation Counselor Self-Employment Process Survey (VRC-SEPS). The VRC-SEPS consists of demographic items, two Likert-type scales examining experiences and readiness, and a set …

Cost Of Caring: The Effects Of Euthanasia On Animal Shelter Workers, Kim L. Nguyen-Finn

Theses and Dissertations

This mixed-methods study focuses on animal shelter workers, a population that has often been overlooked in research and clinical practice, and the emotional strains of the task of euthanasia. The effects of employment in a kill or no-kill shelter, participation in euthanasia, and number of years employed on mental health issues of substance abuse, anxiety, depression, secondary traumatic stress, and burnout were examined. A three-way MANOVA was run to test the hypothesis that there is a cell effect among the type of shelter employed in, participation in euthanasia, and years of experience on mental health, which was not supported by …

A Study Of Counselor Trainees' Self-Perceived Competency In Social Justice Advocacy, Mary Ann Rocha

Theses and Dissertations

The purpose of the study is to examine the social justice advocacy competencies of rehabilitation counselor trainees. The study aims to explore rehabilitation counselor trainees’ self-perceived social justice advocacy competencies. More specifically, counselor trainees’ demographic and training variables will be examined to understand the process of social justice advocacy competency. Also, the study will explore the correlation between social justice advocacy competency and ethical awareness. A convenience sample of counselor trainees who are in a master’s-level or doctoral level rehabilitation counseling program or related counseling program was utilized for this study. In total, 132 counselors in training completed the online …

Factors Contributing To Successful Employment Outcomes For Individuals Who Are Hard-Of-Hearing, Sergio Cuevas

Theses and Dissertations

This study examined the relationship between demographic variables (gender, race and ethnicity, age, level of education, and secondary disability), state-federal vocational rehabilitation (VR) services, and VR employment outcomes among individuals who are hard-of-hearing. This study also explored what VR services contribute to employment outcomes for individuals who are hard-of-hearing. Data from The U.S. Department of Education Rehabilitation Service Administration Case Service Report (RSA-911) FY 2014 was used to focus on individuals who are hard-of-hearing. Logistic regression, Chi-square, and Chi-square Automatic Interaction Detector (CHAID) analyses were used to analyze the RSA-911 dataset.

Certified Rehabilitation Counselors' Self-Perceived Competency In Facilitating End-Of-Life Care Services, Miranda Lopez

Theses and Dissertations

As of 2010, certified rehabilitation counselors (CRC) have been provided ethical guidelines addressing end-of-life care (EOL) service delivery for persons with disabilities. Due to the plethora of pertinent knowledge and skills sets needed to facilitate comprehensive EOL issues, it is vital to examine rehabilitation counselors’ self-perceived competence in facilitating EOL care service delivery. The study was conducted as a non-experimental exploratory design. Based on the study’s sample (N = 188), descriptive statistics reported 70% of counselors lacked education while 69% had not participated in EOL training. Approximately 81% of the participants reported the need for EOL education and training. …

“It's Not Only About Them:“ Female Family Members' Understanding Of Indeterminate Negative Brca1/2 Test Results, Deborah Kay Gibbons

Theses and Dissertations

Genetic test results have important implications for close family members. Indeterminate negative results are the most common outcome of BRCA1/2 mutation testing. Little is known about family members' understanding of indeterminate negative BRCA1/2 test results. The purpose of this qualitative descriptive study was to investigate how daughters and sisters received and understood genetic test results as shared by their mothers or sisters. Participants included 81 women aged 40-74 with mothers or sisters previously diagnosed with breast cancer and who received indeterminate negative BRCA1/2 test results. Participants had never been diagnosed with breast cancer nor received their own genetic testing or …

An Exploration Of The Quality Of Relationship Between Step-Children And Step-Parents Based On Address Term Usage, Sierra R. Payton

Theses and Dissertations

This study aimed to examine address term usage as a communicative component of blended/step-families by examining the address terms that step-children use to address their step-parent and whether address term usage can allude to the quality of relationship reported by step-children within the step-child step-parent relationship. Rowan University undergraduate students (n=67) were recruited to complete questionnaires on address term usage and quality of relationship using the Quality of Relationships Inventory (QRI). Address term usage was the independent variable and was measured using three levels: formal, familiar, and familial. Quality of relationship was the dependent variable and was measured using the …

Demographic Study On 4,038 Sexual Assault Victims: Identifying Vulnerabilities And Vulnerable Populations With Extralegal Variables, Michael Atkerson Worthington

Theses and Dissertations

Sexual assault (SA) is an ongoing concern in the United States (US). With a rate above the national average, SA is especially a concern in the Western state in which this study was conducted. Identifying victim vulnerabilities related to SA is an area of research that is currently limited. In this retrospective study, data on victim vulnerabilities were collected from 4,038 standardized SA forensic medical examination forms. Descriptive statistical analyses were conducted to identify vulnerabilities and Pearson's chi-square tests of association were conducted to explore the relationships between extralegal variables. The extralegal variables represent data not contained within the scope …

Stress Of Trying Daily Therapy Interventions, Emily Kathryn Hansen

Theses and Dissertations

This study is focused on clients' daily experiencing of stress, and measures how this stress might affect their implementation of ideas and recommendations from therapy. Typically, clients attend therapy with the intention of making positive changes. Part of the therapeutic process involves clients completing therapeutic work in their daily lives (Conklin, Strunk, Cooper, 2017); however, stressful tasks and other elements often preclude this therapeutic work from occurring (Kazantzis & L'Abate, 2005). In this study we examine which interventions from therapy are most likely to be attempted at home, and the level of stress in making these attempts. A series of …

The Persistence Of The Associate Degree Nursing Student: The Lost Nurse, Stella A. Barber

Theses and Dissertations

There is controversy surrounding the entry-level degree to the profession of nursing. This study had the focus of showing the persistence of the associate degree nursing student as a way of giving evidence to maintaining this pathway as entry to nursing. Narrative inquiry was used to interview 10 students and 3 faculty on the persistence of the nursing student. Callista Roy's Coping Adaptation Processing Scale was taken by 51 students enrolled in the same nursing program. The overarching themes of the student interviews were goals, learning environment, and admission criteria. The overarching theme as a result of the Coping Adaptation …

The Role Of Cdk8 In Metastatic Growth Of Colon Cancer, Jiaxin Liang

Theses and Dissertations

Unresectable hepatic metastases of colon cancer poorly respond to existing therapies and are a major cause of colon cancer lethality. Transcription- regulating Mediator kinase CDK8, an early clinical stage drug target, is amplified or overexpressed in many colon cancers and CDK8 expression correlates with shorter patient survival. Here we show that CDK8 inhibition does not generally suppress proliferation of CDK8-overexpressing colon cancer cells but nevertheless CDK8 knockdown by shRNA or CDK8 kinase inhibition by a selective small-molecule drug candidate suppresses metastatic growth of mouse and human colon cancer cells in the liver. This effect is due at least in part …